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    30 October 2020, Volume 35 Issue 10
    Development and application of clinical determination and treatment for carbapenem-resistant Enterobacteriaceae
    WANG Su, ZHAO Hu
    2020, 35(10):  967-970.  DOI: 10.3969/j.issn.1673-8640.2020.10.001
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    With the overload use of broad-spectrum antibacterial drugs,multi-drug resistant bacteria,represented by carbapenem-resistant Enterobacteriaceae(CRE),have been rapidly spread,which has greatly threaten clinical anti-infection treatment. In this issue "The development and application of clinical determination and treatment for carbapenem-resistant Enterobacteriaceae",4 original articles and 2 reviews introduce different determination techniques and treatment strategies of CRE,which provides a reference for clinical diagnosis,treatment and prevention of CRE.

    Determination methods for carbapenem-resistant Enterobacteriaceae
    ZHOU Hongwei, HU Yanyan, ZHANG Rong
    2020, 35(10):  971-973.  DOI: 10.3969/j.issn.1673-8640.2020.10.002
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    The infection caused by carbapenem-resistant Enterobacteriaceae(CRE) brings a challenge for clinical treatment,and timely and accurately identifying carbapenemase plays a role in guiding clinical antibiotic application. At present,the determination methods of carbapenemase include phenotypic screening,gene determination and the methods based on matrix-assisted laser desorption/ionization time-of-flight mass spectrometry(MALDI-TOF MS). This review focuses on various determination methods for CRE.

    Research status of decolonization strategy of carbapenem-resistant Enterobacteriaceae
    ZOU Chengyun, YANG Hongmei, WANG Haiying
    2020, 35(10):  974-978.  DOI: 10.3969/j.issn.1673-8640.2020.10.003
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    The treatment options of multi-drug resistance bacterial infection are limited,and are often inefficient,especially for carbapenem-resistant Enterobacteriaceae(CRE). The colonization of CRE will increase the risk of CRE infection,and the clinical mortality will increase. This review summarizes the epidemiological characteristics of CRE,the hazard of colonization and the existing prevention and control measures,which discusses the feasibility and effectiveness of 2 decolonization strategies,including selective digestive decontamination(SDD) and fecal bacterium transplantation(FMT),which have attracted international attention recently. This review also enumerates the advantages and disadvantages of the 2 methods of decolonization and the problems that need to be solved in the future. Although there is little research evidence on the effectiveness of FMT to decolonize CRE,it is none the less a reliable choice for CRE decolonization.

    Role of double concentration combined modified carbapenem inactivation test for screening CRE
    LI Shirong, LIN Lijing, JIANG Xiaofei, GUAN Ming
    2020, 35(10):  979-982.  DOI: 10.3969/j.issn.1673-8640.2020.10.004
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    Objective To evaluate the role of double concentration combined modified carbapenem inactivation method(mCIM) for screening carbapenem-resistant Enterobacteriaceae(CRE). Methods Based on the drug susceptibility test of VITEK 2 Compact N335 card,231 isolates of Enterobacteriaceae isolated from clinical samples were screened for CRE by double concentration combined mCIM. Results Totally,52 isolates of CRE were screened by VITEK 2 Compact N335 card,179 isolates were negative,and the positive rate was 22.5%. Totally,52 isolates of CRE were screened by mCIM. A total of 53 isolates of CRE were screened by double concentration combined mCIM,178 isolates were negative,and the positive rate was 22.9%. Based on the durg susceptibility test of VITEK 2 Compact N335 card,the consistency rate,sensitivity and specificity were 98.7%,98.1% and 98.9%,respectively. A total of 52 isolates with positive mCIM results were continued to do ethylenediamine tetraacetic acid-modified carbapenem inactivation method(eCIM). The results showed that 13 isolates of Enterobacteriaceae were metallo-β-lactamase positive,and the positive rate of carbapenemases was 25%. Conclusions The double concentration combined mCIM for CRE screening has the advantages of simple operation,no need for special instruments and easy observation of results. It is suitable for using in all level microbiological laboratories. It is necessary for mCIM positive isolates to do eCIM again,which is conducive to individualized drug use in clinic.

    Clinical application of RT-PCR for Klebsiella pneumoniae producing KPC carbapenemase
    HE Lihua, NI Lijun, YANG Simin, YU Xiaoyu, ZHOU Aiping, HU Liang, GUO Jian, WU Wenjuan
    2020, 35(10):  983-987.  DOI: 10.3969/j.issn.1673-8640.2020.10.005
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    Objective To evaluate the consistency of fluorescent quantitative real-time polymerase chain reaction(RT-PCR) and polymerase chain reaction(PCR) amplification for carbapenem-resistant Klebsiella pneumoniae(CRKP) producing KPC carbapenemase,and to evaluate the performance of RT-PCR for the direct determination of Klebsiella pneumoniae and blaKPC gene in clinical specimens. Methods Totally,89 clinical isolates of CRKP were collected. The determination rates and consistency of the 2 methods were compared. A total of 226 sputum specimens were collected. The blaKPC gene and blaphoE gene of outer membrane phospholipid protein of Klebsiella pneumoniae in clinical specimens were determined by RT-PCR. Traditional culture and drug susceptibility test were carried out to evaluate consistency. Results Among the 89 CRKP isolates,the determination rate of blaphoE gene was 100%,and 2 isolates did not determineblaKPC gene by RT-PCR and PCR amplification. The determination rate of blaKPC was 97.8%,and the consistency of the 2 methods was 100%. In the 226 sputum specimens,for the determination of blaphoE gene of Klebsiella pneumoniae by RT-PCR,using the results of culture as standard,the sensitivity,specificity and consistency of the 2 methods were 100%,99.38% and 99.56%,respectively. Using the results of drug susceptibility test as standard,for the determination of blaKPC gene of Klebsiella pneumoniae by RT-PCR,the sensitivity,specificity and consistency of the 2 methods were 95.56%,99.48% and 98.67%,respectively.Conclusions Klebsiella pneumoniae producing KPC carbapenemase can be rapidly screened by RT-PCR,which can provide a reference for rapid anti-infection treatment in patients with severe infection.

    In vitro antibacterial activity of ceftazidime/avibactam alone and in combination with fosfomycin against carbapenem-resistant Gram-negative bacilli
    CHEN Tao, XU Ye, DONG Guofeng, ZHOU Cui, XU Wenya, ZHOU Tieli
    2020, 35(10):  988-993.  DOI: 10.3969/j.issn.1673-8640.2020.10.006
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    Objective To investigate in vitro antibacterial activity of a novel β-lactam/β-lactamase inhibitor ceftazidime(CAZ)/avibactam(AVI) alone and in combination with fosfomycin against carbapenem-resistant Gram-negative bacilli. Methods A total of 56 carbapenem-resistant Escherichia coli(CREC),43 carbapenem-resistant Klebsiella pneumoniae(CRKP),53 carbapenem-resistant Pseudomonas aeruginosa(CRPA),51 carbapenem-susceptible Escherichia coli(CSEC),43 carbapenem-susceptible Klebsiella pneumoniae(CSKP) and 51 carbapenem-susceptible Pseudomonas aeruginosa(CSPA) were collected from the First Affiliated Hospital of Wenzhou Medical University from 2014 to 2017. The minimum inhibitory concentration(MIC) against CAZ/AVI was determined by agar dilution method. The fractional inhibitory concentration index(FICI) of CAZ/AVI in combination with fosfomycin was determined by checkerboard method to evaluate the combined antibacterial effect. Results The total resistance rate of 297 Gram-negative bacilli to CAZ/AVI was 18.18%. The resistance rate of carbapenem-resistant Gram-negative bacilli to CAZ/AVI was 30.26%,which was higher than that of carbapenem-susceptible isolates(5.52%)(P<0.05). The resistance rate of CRKP to CAZ/AVI was 9.3%,which was lower than those of CREC and CRPA(39.29% and 37.74%)(P<0.05). CAZ/AVI in combination with fosfomycin showed synergistic effect on CRKP and CRPA and additive effect on CREC. Conclusions CAZ/AVI has a high in vitro antibacterial activity towards CRKP,and can be the first choice for clinical treatment of CRKP. CAZ/AVI in combination with fosfomycin may be a new treatment strategy for the treatment of 3 common carbapenem-resistant Gram-negative bacilli.

    Clinical evaluation of Polymyxin NP test for screening polymyxin-resistant Enterobacteriaceae
    TANG Yu, SHEN Pinghua, SHI Baoqing, JIANG Xiaofei
    2020, 35(10):  994-999.  DOI: 10.3969/j.issn.1673-8640.2020.10.007
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    Objective To evaluate the clinical role of Polymyxin NP test for screening polymyxin-resistant Enterobacteriaceae. Methods A total of 461 isolates of Enterobacteriaceae were screened by Polymyxin NP test preliminarily. Broth microdilution method was performed to determine minimum inhibitory concentration(MIC) of polymyxin,and Kirby-Bauer method was used to determine the in vitro antimicrobial susceptibility of common antibiotics. Polymyxin-related genes,including pmrA,pmrB,phoP,phoQ,mgrB and mcr,were determined by polymerase chain reaction(PCR) and sequencing. Real-time quantitative polymerase chain reaction(qRT-PCR) was performed to determine the expression levels of genes associated with pmrA/pmrB,pmrD/pmrF and PhoP/PhoQ regulatory systems. Results Among the 461 Enterobacteriaceae isolates,within 2 h,13 polymyxin-resistant isolates were positive in Polymyxin NP test,and polymyxin-susceptible isolates were negative. Totally,10 of 13 polymyxin-resistant isolates belonging to Klebsiella pneumoniae resulted from insertion of mgrB as well as mutants and expression increasing of pmrA/pmrB and PhoP/PhoQ regulatory systems,and 1 isolate belonging to Escherichia coli was mediated bymcr-1 in plasmid. The resistance mechanisms of 2 isolates of Enterobacter cloacae were still unclear. There was no statistical significance between polymyxin-resistant and polymyxin-susceptible isolates(P>0.05). Conclusions Polymyxin NP test is easy to perform and reliable. It could be used in screening polymyxin-resistant Enterobacteriaceae mediated by various mechanisms,which can provide a reference for treating infectious diseases and preventing the prevalence of resistance.

    Analysis of clinical symptoms and laboratory determination results of 92 patients with COVID-19
    XU Yuanhong, LI Qingfeng, ZHU Ma, WANG Dongmei, LUO Jia, LI Yingjie, XU Jiao, SHANG Pengcheng, ZENG Peibin
    2020, 35(10):  1000-1004.  DOI: 10.3969/j.issn.1673-8640.2020.10.008
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    Objective To analyze the clinical symptoms and laboratory determination results of 92 patients with corona virus disease 2019(COVID-19). Methods The clinical symptoms,diagnosis and classification data of 92 patients with COVID-19 were analyzed retrospectively. The results of the first-time laboratory determination results [white blood cell(WBC) count,the absolute value of neutrophil(NEUT #),the absolute value of lymphocyte(LYMPH #),CD3+ cell,CD4+ cell,CD8+ cell,C-reactive protein(CRP),serum amyloid A(SAA) and Mycoplasma pneumoniae(MP) antibody] were collected. Results Among the 92 patients,there were 35 patients in severe group and 57 patients in mild group. The clinical symptoms of visit were mainly fever(77.2%),cough(66.3%) and general fatigue(26.1%),of which cough was mainly coughing white foamy sputum(41.0%) and dry cough(36.1%). The first clinical symptoms were cough and fever with cough. Totally,80.7% patients had normal WBC count,84.2% had normal NEUT#,and 80.7% had normal LYMPH#. CD3+ cell,CD4+ cell and CD8+ cell decreased in 59.3%,56.0% and 51.6% patients,respectively. CRP was increased in 64.1% patients,SAA was increased in 72.8% patients,and MP antibody was positive in 55.7% patients. NEUT#,CRP and SAA in severe group were higher than those in mild group(P<0.05),and LYMPH# and CD3+ cell,CD4+ cell and CD8+ cell were lower(P<0.05). Conclusions It is necessary to be alert to patients whose the first clinical symptom is only cough without fever or cough first and then fever. Laboratory determination indicators(NEUT#,LYMPH#,CRP,SAA,CD3+ cell,CD4+ cell and CD8+ cell) can help clinicians to identify critically ill patients as soon as possible.

    Roles of SAA,CRP and LYMPH# in clinical classification and efficiency evaluation of corona virus disease 2019
    TANG Shengyao, LIU Guosheng, CHU Zhihua, DU Guiyan, ZHOU Shuchu, ZHOU Fawei
    2020, 35(10):  1005-1007.  DOI: 10.3969/j.issn.1673-8640.2020.10.009
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    Objective To study the roles of serum amyloid A(SAA),C-reactive protein(CRP)and the absolute value of lymphocyte(LYMPH#) in clinical classification and efficiency evaluation of corona virus disease 2019(COVID-19). Methods Totally,45 patients with COVID-19,including 31 cases of light type and 14 cases of severe type,which were all improved and discharged,were enrolled,and 50 suspected patients without severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infection were enrolled as disease control group. A total of 60 healthy subjects were enrolled as healthy control group. SAA,CRP and LYMPH# were determined. Results In severe type group,SAA,CRP and LYMPH# in light type group,disease control group and healthy control group had statistical significance(P<0.05). CRP in light type group was lower than that in disease control group(P<0.05),and there was no statistical significance for SAA and LYMPH# between the 2 groups(P>0.05). SAA in light type group was higher than that in healthy control group(P<0.05),and LYMPH# was lower(P<0.05). There was no statistical significance for CRP between the 2 groups(P>0.05). Compared with the time of admission,SAA and CRP in COVID-19 group were decreased(P<0.05),and LYMPH# was increased(P<0.05). Conclusions SAA,CRP and LYMPH# play roles in clinical classification and efficiency evaluation of COVID-19.

    Diagnostic value of serum total calcium level in the prognosis of severe COVID-19 patients
    WANG Jianru, BAI Huan, ZHANG Chi
    2020, 35(10):  1008-1012.  DOI: 10.3969/j.issn.1673-8640.2020.10.010
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    Objective To investigate the role of serum calcium level in the prognosis of severe corona virus disease 2019(COVID-19) patients. Methods The data(sex,age,past medical history,complications,outcomes and so on),C-reactive protein(CRP),procalcitonin(PCT),serum glucose,serum calcium and acute physiology and chronic health evaluation scoring system Ⅱ(APACHE Ⅱ) within 24 h of intensive care unit(ICU) admission and 28 d mortality of 69 patients with severe COVID-19 were collected and analyzed retrospectively. According to serum calcium levels,the patients were classified into normal group(serum calcium 2.11-2.52 mmol/L) and hypocalcemia group(serum calcium < 2.11 mmol/L). According to 28 d prognosis,the patients were classified into survival group and death group. Spearman correlation analysis was used for correlation analysis. Receiver operating characteristic(ROC) curve was used to evaluate the diagnostic value of serum calcium level for prognosis. Kaplan-Meier survival analysis was used to compare accumulative survival rate. Results The incidence of hypocalcemia in patients with severe COVID-19 was 57.97%. The prevalence of chronic kidney disease,age,CRP,serum glucose,APACHEⅡ and the proportions of the complications of acute respiratory distress syndrome(ARDS),shock and hypoalbuminemia in hypocalcemia group were higher than those in normal group(P<0.05). However,there was no statistical significance in sex and PCT between the 2 groups(P>0.05). Spearman correlation analysis showed that there was a negative correlation between serum calcium level and CRP,serum glucose and APACHEⅡ(r values were -0.48,-0.41 and -0.65,respectively,P<0.05),but there was no correlation with PCT(r=-0.18,P>0.05). ROC curve analysis showed that the area under curve(AUC) of serum calcium for predicting the prognosis of severe COVID-19 was 0.777. The 28 d accumulative survival rate of hypocalcemia group was lower than that of normal group through Kaplan-Meier survival analysis(P=0.019).Conclusions The prognosis of severe COVID-19 patients with hypocalcemia is poor. Serum calcium may be used as a predictor for prognosis in patients with severe COVID-19.

    Genotype and phenotype analysis of familial hypomagnesemia with hypercalciuria and nephrocalcinosis caused by CLDN16 mutation
    BAOERHAN Reyilanmu, LI Yan, LUO Yanfei, SUN Guanghui, JULAITI Dilihuma, MAIMAITI Mireguli
    2020, 35(10):  1013-1018.  DOI: 10.3969/j.issn.1673-8640.2020.10.011
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    Objective To investigate the genotype and phenotype characteristics of familial hypomagnesemia with hypercalciuria and nephrocalcinosis(FHHNC) caused by CLDN16 mutation. Methods The clinical data and laboratory determination results of a case of FHHNC were analyzed retrospectively,and pedigree survey and gene sequencing were performed. Results Physical examination showed backward development,special features(flat nose,wide eye space,short neck),chicken breast,bent limbs,enlarged elbow and knee joints and passive cross-legged sitting. Laboratory determination results showed decreased blood calcium and magnesium,increased urinary calcium and decreased 25-hydroxyvitamin D. Imaging revealed skeletal system abnormalities. Whole exon gene sequencing indicated that the CLDN16 gene of the case had "missense variation c. 647G>A,p. arg216his(homozygous)",and the parents of the case carried this locus variation(heterozygous). Combined with the results of relevant tests,the diagnosis was FHHNC clearly. Conclusions FHHNC is involved in CLDN16/CLDN19 gene mutations. FHHNC patients usually exhibit hypomagnesemia with hypercalciuria and nephrocalcinosis,and it can accompanied by ricket and other skeletal system abnormalities. Whole exon sequencing can be helpful for FHHNC diagnosis.

    Efficiency and prognosis role of fibrinogen/prealbumin ratio in Ⅱ-Ⅲ colorectal cancer patients undergoing adjuvant chemotherapy
    ZHOU Hangliang, CHEN Xianbao, CUI Yingshan, YING Houqun
    2020, 35(10):  1019-1024.  DOI: 10.3969/j.issn.1673-8640.2020.10.012
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    Objective To investigate the efficiency and prognosis role of preoperative albumin/fibrinogen ratio(AFR) and fibrinogen/prealbumin ratio(FPR) in Ⅱ-Ⅲ colorectal cancer patients undergoing adjuvant chemotherapy. Methods A total of 212 colorectal cancer patients were enrolled. Their clinical data and the results of fibrinogen(Fib),albumin(Alb) and prealbumin(PA) were collected. These patients were followed up for 3 years. The relationship of the parameters with adjuvant chemotherapy efficiency and prognosis was evaluated. Results The optimal cut-off values of Fib,Alb,PA,FPR and AFR were 3.50 mg/L,40.00 g/L,180.00 mg/L,18.00 and 12.50,respectively. Overall survival time of low AFR group was shorter than that of high AFR group(P=0.02),and overall survival time of low FPR group was longer than that of high FPR group(P<0.01). The results of Cox regression showed that Alb(>40.00 g/L),PA(>180.00 mg/L) and FPR(>18.00) were correlated with overall survival of the patients [adjusted hazard ratios(HR) were 0.64,0.52 and 3.40;95% confidence intervals(CI) were 0.34-0.92,0.39-0.83 and 1.36-5.06,respectively). However,Fib(adjusted HR=1.40,95%CI 0.91-2.18) and AFR(adjusted HR=0.79,95%CI 0.45-1.17) were not correlated with overall survival of the patients. The area under curve of FPR was 0.76 for predicting the survival of the patients,which was higher than those of CEA(0.73),CA19-9(0.68),Alb(0.70) and PA(0.72). The survival of high FPR group without chemotherapy was inferior to that undergoing chemotherapy(adjusted HR=6.41,95%CI 2.97-13.30). Conclusions Preoperative FPR is associated with clinical efficiency of chemotherapy and prognosis,and it could used as an independent biomarker to predict the overall survival of colorectal cancer patients.

    Correlation of serum bilirubin and CK-MB mass with age in newborns
    ZHENG Gaoming, SU Xiaoru
    2020, 35(10):  1025-1027.  DOI: 10.3969/j.issn.1673-8640.2020.10.013
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    Objective To investigate the relationship between total bilirubin(TB),direct bilirubin(DBil)and creatine kinase isoenzyme MB mass(CK-MB mass)with age in newborns. Methods A total of 106 newborns aged 0-28 d were classified into 3 groups according to birth days,which included ≤5 d group(48 cases),>5-≤10 d group(32 cases) and >10-≤28 d group(26 cases). Spearman correlation analysis was used to evaluate the correlation between each index and age. Results Serum TB level in >5-≤10 d group was higher than those in ≤5 d and >10-≤28 d groups(P<0.001),and DBil level in >10-≤28 d group was higher than those in ≤5 d and >5-≤10 d groups(P<0.001),while serum CK-MB mass in ≤5 d,>5-≤10 d and >10-≤28 d groups was decreased in turn(P<0.05). There was no correlation between TB and age(r=0.038,P>0.05),DBil was correlated positively with age(r=0.469,P<0.05),and there was a negative correlation between CK-MB mass and age(r =-0.559,P<0.05). Conclusions DBil and CK-MB mass in newborns have a certain relationship with age.

    Analysis of serum 25-hydroxyvitamin D levels in healthy subjects
    ZHANG Sujie, JU Yi, LI Qing, SUN Hewei, FENG Xueqing, JIN Zhonggan, LI Shuijun, LI Yujie, LI Jinrong
    2020, 35(10):  1028-1031.  DOI: 10.3969/j.issn.1673-8640.2020.10.014
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    Objective To analyze the levels of 25-hydroxyvitamin D [25(OH)D] in healthy subjects. Methods A multicenter retrospective study was conducted in 974 healthy subjects who were enrolled from 3 laboratories. The 25-hydroxyvitamin D2 [25(OH)D2] and 25-hydroxyvitamin D3 [25(OH)D3] levels were determined by isotope dilute liquid chromatography tandem mass spectrometry(ID LC-MS/MS). The data were analyzed statistically. Results After removing 23 outliers,serum 25(OH)D2,25(OH)D3 and 25(OH)D levels of 951 healthy subjects were non-normally distributed. Female serum 25(OH)D3 and 25(OH)D levels were higher than those in males(P<0.01),and there was no statistical significance for serum 25(OH)D2 levels between males and females(P>0.05). The healthy subjects were classified into 1-17 years old group,18-29 years old group,30-39 years old group,40-49 years old group,50-59 years old group,60-69 years old group,70-79 years old group,80-89 years old group and 90-100 years old group. The 25(OH)D levels of males and females in 1-17 years old group were higher than those in the other age groups(P<0.01). There was no statistical significance in 25(OH)D levels in 18-79 years old groups(P>0.05). Those in 80-89 years old group and 90-100 years old group were lower than those in the other age groups(P<0.05,P<0.01). Comparing those of males and females in the same age group,the 25(OH)D levels of females >50 years old were higher than those of males(P<0.01),and there was no statistical significance between males and females in the other age groups(P>0.05). The percentile method was used to evaluate serum 25(OH)D levels in healthy subjects,of which that of females was 3.5-31.5 ng/mL,and that of males was 2.7-29.8 ng/mL. Conclusions The distribution of serum 25(OH)D levels of healthy subjects based on mass spectrometry provides a reference for clinical diagnosis and treatment.

    Correlation between cystatin C,α-klotho protein,sICAM-1 and diabetic nephropathy
    CHEN Jun
    2020, 35(10):  1032-1035.  DOI: 10.3969/j.issn.1673-8640.2020.10.015
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    Objective To investigate the correlation between cystatin C(Cys C),α-klotho protein,serum soluble intercellular adhesion molecule-1(sICAM -1) and diabetic nephropathy(DN). Methods A total of 160 patients with type 2 diabetes mellitus(T2DM) were enrolled. The patients were classified into 2 groups according to urinary albumin to creatinine ratio(ACR). There were 40 cases of simple T2DM group(ACR<30 mg/g),60 cases of early DN group(ACR 30-300 mg/g) and 60 cases of clinical DN group(ACR>300 mg/g). Totally,60 healthy subjects were enrolled as healthy control group. The levels of serum Cys C,α-klotho protein,sICAM-1 and kidney function indexes [serum creatinine(Cr),uric acid(UA) and blood urea nitrogen(BUN)] were determined. Pearson correlation analysis was used to evaluate the correlation between Cys C,α-klotho protein,sICAM-1 and ACR. Receiver operating characteristic(ROC) curve analysis was used to evaluate the efficiency of early kidney injury in T2DM patients. Results Serum levels of Cys C,sICAM-1,Cr,UA and BUN in T2DM patients were higher than those in healthy control group(P<0.05),and serum α-klotho protein was lower(P<0.05). Cys C and sICAM-1 were increased with the progress of DN conditions(P<0.05),and serum α-klotho protein was decreased with the severity of DN(P<0.05). Cys C and sICAM-1 were positively correlated with ACR(r=0.562 and 0.613,respectively,P<0.05),and serum α- Klotho protein was negatively correlated with ACR(r=-0.702,P<0.05). ACR>30 mg/g was used as the criterion of early kidney injury in T2DM patients. The areas under curves(AUC) of Cys C,sICAM-1 and serum α-klotho protein for the diagnosis of early kidney injury in T2DM patients were 0.796,0.801 and 0.795,respectively. The optimal cut-off values were 1.39 mg/L,352.61 ng/mL and 531.95 pg/mL,the sensitivities were 73.75%,82.50% and 75.00%,and the specificities were 80.00%,68.33% and 76.67%,respectively. Conclusions Cys C,sICAM-1 and serum α-klotho protein play roles in the diagnosis of early kidney injury among T2DM patients.

    Phenotype and genotype analysis of coagulation factor Ⅺ deficiency caused by a compound heterozygous mutation
    BI Xiaojie, HUANG Daochao, JIN Xianfu, JIANG Junyu, SU Zhengxian, CHEN Chaochao, SHEN Bo
    2020, 35(10):  1036-1039.  DOI: 10.3969/j.issn.1673-8640.2020.10.016
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    Objective To analyze the phenotype and genotype of a family with congenital coagulation factor(F) Ⅺ deficiency,and to investigate its molecular pathogenesis. Methods Peripheral blood samples of proband and family members(8 persons in 3 generations) were collected,and coagulation-related indicators in upper plasma were determined. Totally,13 exons and 5' non-translation regions of F11 were amplified by polymerase chain reaction(PCR),and sequencing analysis was performed. The corresponding mutation sites of family members were detected. The segment with mutation was sequenced backward. The effects of mutation sites on proteins were analyzed by bioinformatics softwares(PolyPhen-2,Mutation Taster and SIFT). Results The activated partial thromboplastin time(APTT) of proband was 162 s,FⅪ activity was 2%,and FⅪ antigen was 3.6%. His father,mother,sister and son all presented prolonged APTT with markedly decreased values of FⅪ activity and FⅪ antigen. Sequencing analysis showed cDNA.1640G>A and cDNA.2183G>A compound heterozygous mutations in F11 gene were from his father and mother,respectively. The results of bioinformatics softwares showed that the mutations could affect the function of protein and lead to the occurrence of corresponding diseases. Conclusions The compound heterozygous mutations of cDNA.1640G>A and cDNA.2183G>A in F11 gene may cause the decreased FⅪ activity in the patient.

    Laboratory determination characteristic of 95 patients with monoclonal gammopathy of undetermined significance
    LIN Xiaoyi, LU Jie, SHI Xinming
    2020, 35(10):  1040-1042.  DOI: 10.3969/j.issn.1673-8640.2020.10.017
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    Objective To study the laboratory determination characteristic of 95 patients with monoclonal gammopathy of undetermined significance(MGUS). Methods Totally,95 patients with MGUS were enrolled. The age and sex were recorded,and the amount and subtype of monoclonal protein were determined.Results The monoclonal immunoglobulin was IgG in 63 cases,IgA in 22 cases,IgM in 8 cases,biclonal in 1 case and light chain in 1 case. The amounts of monoclonal protein were 5.2(2.6~8.6)g/L in IgG MGUS,4.9(3.2~8.6)g/L in IgA MGUS and 5.1(4.2~6.9)g/L in IgM MGUS,respectively. The κ/λ ratios were 2.2(0.7~4.2) in IgG MGUS,1.7(1.1~3.0) in IgA MGUS and 1.6(0.9~3.4) in IgM MGUS,respectively. The average amount of monoclonal protein was 6.3 g/L in 95 patients,and 7 cases had a concentration of ≥15 g/L. There was no statistical significance in patients' age,sex,monoclonal protein amount and κ/λ ratios in each subtype(P>0.05). Two cases(1 case of light chain type and 1 case of IgG λ) transformed into multiple myeloma(MM),and one case transformed into smoldering myeloma(IgG κ) and one case transformed into smoldering Waldenström macroglobulinemia(IgM κ),respectively,in 1 year. Conclusions IgG MGUS is the most common subtype,followed by IgA MGUS. It should pay attention to identify high-risk populations of MGUS and standardize their follow-up to make them be diagnosed and treated in the early stage of disease progression.

    Establishment and performance evaluation of chemiluminescent microparticle immunoassay for the determination of high concentration HbsAg
    LIU Yang, ZHANG Zhiping, PENG Daorong, SONG Liuwei, GE Shengxiang, HAO Xiaoke, LIU Jiayun
    2020, 35(10):  1056-1061.  DOI: 10.3969/j.issn.1673-8640.2020.10.022
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    Objective To establish a chemiluminescent microparticle immunoassay(CMIA) for the quantitative determination of hepatitis B surface antigen(HBsAg) and conduct performance evaluation. Methods Mouse-specific anti-HBsAg antibody was coated on the surface of magnetic particle to bind the corresponding HBsAg. The specific anti-HBsAg antibody labeled with acridinium ester was added to form a double antibody sandwich immune complex on the surface of magnetic particle. Pre-trigger solution and trigger solution were added. The acridinium ester on the complex was excited to emit photons,and the relative light unit was proportional to HBsAg concentration. The best reaction conditions were screened,and the performance of self-established CMIA for determining HBsAg(linear range,determination limit,precision,interference,cross-reaction,stability,correlation and consistency with electrochemiluminescence method) was evaluated. Results The optimal concentration of magnetic particles was 0.4 mg/mL,and the optimal dilution ratio of acridinium ester-labeled antibody was 1:200(a concentration of 250 ng/mL). The amounts of reaction diluent,sample and reagent were 100,20 and 50 μL,respectively. The linear range of self-established CMIA to determine HBsAg was 20-100 000 IU/mL,the minimum determination limit was 9.9 IU/mL,and the within-run and between-run coefficents of variation(CV) were <10.0%. The self-established CMIA was not affected by the interference factors,such as hemoglobin<400 mg/L,bilirubin<4 mg/L,rheumatoid factor<800 IU/mL,triglyceride<2 mg/L,sodium citrate<22 mmol/L and ethylenediaminetetraacetic acid(EDTA)<8 mmol/L. Hepatitis A virus(HAV),hepatitis C virus(HCV),hepatitis E virus(HEV),human immunodeficiency virus(HIV),human T-lymphotropic virus(HTLV),cytomegalovirus(CMV)and Epstein-Barr virus(EBV)positive samples did not cross-react with this assay. The prepared reagent could be stable for 6 d at 37 ℃,it could be stable for 4 weeks after opening lid at 2-8 ℃,and it could be stable for 6 months when stored in a sealed container at 2-8 ℃. The correlation and consistency between self-established CMIA and electrochemiluminescence method were good(r=0.978,P<0.001). Conclusions The self-established CMIA has a wide linear range for determining HBsAg,high concentration samples can be directly determined without dilution,and the determination performance is good,which has certain clinical application prospects.

    LncRNA SNHG1 promoting the growth of gastric cancer through binding to miR-145
    ZHOU Fengli, CHU Yimin, LI Ji, YANG Daming, PENG Haixia, XU Ying
    2020, 35(10):  1062-1069.  DOI: 10.3969/j.issn.1673-8640.2020.10.023
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    Objective To investigate small nucleolar RNA host gene 1(SNHG1) promoting the growth of gastric cancer through binding to microRNA-145(miR-145). Methods Kaplan-Meier Plotter database analyzed the correlation of SNHG1 with gastric cancer overall survival. Bioinformatics analysis and real-time fluorescence quantitation polymerase chain reaction(qRT-PCR) were used to investigate the expression level and the expression relationship of SNHG1 and miR-145 in gastric cancer. The influence of overexpression and knock-down of SNHG1 on the growth of gastric cancer cell was determined by CCK8 assay. Luciferase reporter gene assay studied the interaction between SNHG1 and miR-145. Western blot was used to determined the change of CTNNB1 and MYC protein with the transfection of SNHG1,miR-145 and SNHG1 with miR-145. Results The overall survival of patients with low SNHG1 expression was longer than that of patients with high SNHG1 expression(P=0.015). Compared to adjacent tissues,the expression level of SNHG1 in gastric cancer tissues was increased(P<0.05). The overexpression of SNHG1 promoted the growth of gastric cancer cells,while knock-down SNHG1 inhibited cell growth. Luciferase reporter assay showed that SNHG1 could bind to miR-145 effectively. The miR-145 down-regulated the expressions of CTNNB1 and MYC proteins,SNHG1 promoted the expressions of CTNNB1 and MYC proteins,and SNHG1 inhibited the down-regulation of CTNNB1 and MYC proteins by miR-145. Conclusions The over-expressed SNHG1 in gastric cancer binding to miR-145 enhances the expression of CTNNB1 and MYC proteins that could promote gastric cancer growth.

    Research progress of macrolide-resistant Mycoplasma pneumoniae
    WANG Bingjie, ZHANG Hong
    2020, 35(10):  1070-1074.  DOI: 10.3969/j.issn.1673-8640.2020.10.024
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    Mycoplasma pneumoniae(MP) is one of the predominant pathogens causing community-acquired pneumonia(CAP). In recent years,the prevalence of macrolide-resistant Mycoplasma pneumoniae(MRMP) has rapidly increased in worldwide. MRMP was highly prevalent in Asia,especially in China,South Korea and Japan,while the prevalence is relatively low in North America,Europe and Africa. The resistance mechanism of MP mainly dues to the mutation of 23S rRNA gene. The single point mutation in the 23S rRNA gene is the main macrolide resistance mechanism of MRMP,which can reduce the affinity of macrolide antibiotics with ribosomes and then develop resistance.. The positive rate of MRMP P1-I or MLVA4-5-7-2 is higher than other types. The key for controlling the infection of MP is rapid diagnosis and rational use of antibiotics. Although there are several rapid determination methods reported,they do not have a uniform standard, and also not routinely used in clinical practice. It is still necessary to explore the most suitable rapid detection method for MP.